Medicare Advantage Contract Termination FAQ's

Frequently Asked Questions - Medicare Advantage Contract Termination

• Q: What is a Medicare advantage (MA) plan?

  A: A Medicare Advantage Plan (MA) is also known as Medicare Part C and is a private health plan that offers an alternative to Traditional Medicare. MA plans provide coverage for Part A (Hospital insurance), and part B (Medical Insurance), and can often include Part D (prescription drug coverage). Some MA plans may offer additional benefits like Vision, dental, or hearing. However, MA plans do operate within networks, meaning patients should see a provider within their MA’s network. MA plans have their own premium to be paid by the enrollee in addition to the Premium for part A/B coverage.

• Q: What is the difference between MA plans and Traditional Medicare?

  A: From a hospital standpoint, Traditional Medicare is the most comprehensive medical coverage. Unlike MA plans, Traditional Medicare does not have network limitations, patients can visit any doctor or hospital that takes Medicare in the US, and in many cases, referrals are not required like they are with MA plans.  Additionally, patients can purchase a Medigap plan to cover the out-of-pocket costs associated with Traditional Medicare. Medicare Advantage plans also have out-of-pocket costs, but do not allow for a secondary Medigap policy to cover the out- of-pocket costs. 

           For more information on MA, Traditional Medicare, or comparing the two, please visit: Medicare.gov

• Q: Is the United Healthcare AARP Medicare supplemental plan affected?

  A: Medigap (Part F) policies are not affected, including AARP.

• Q: How do I know when Carson Tahoe will be out of network with my specific plan?

  A: The most recent list of termination dates for these plans can be found here: https://www.carsontahoe.com/ctmg-insurance.html

• Q: Why is Carson Tahoe terminating its contract with Most Medicare Advantage plans.

  A: Carson Tahoe Health diligently monitors its contracts and relationships with health insurance companies to ensure patients’ claims are addressed thoroughly, properly, and timely. Through this review, we have determined that processing of requests and claims jeopardizes Carson Tahoe Health’s ability to provide appropriate care to these Medicare Advantage members and customers while continuing as a local not-for-profit, independent hospital whose mission is to enhance the health and well-being of the communities we serve.

• Q: What Medicare advantage plans will be accepted?
• A: Prominence and Senior Care Plus are the only Medicare Advantage plans that will be accepted through benefit year 2025. These are local carriers which allow for strong communication and relationships between CTH, the patient, and the policy. Senior Care Plus is available to residents of Washoe, Carson, and Storey counties. Prominence is available to residents of Carson, Douglas, Lyon, Storey, and Washoe counties. To explore what these plans are offering, visit Medicare.gov and input your zip code to compare. 

• For more information or to speak with a representative: Senior Care Plus: Call 775-982-3112 Toll Free: 888-775-7003 or visit seniorcareplus.com Prominence:Medicare Enrollment: Call 866-747-8855 (TTY Service: 711) Member Services: 855-969-5882 or visit ProminenceMedicare.com

• Q: Will CTH continue to schedule appointments if my coverage is out of network?

  A: CTH never wants to deny patients from receiving care. However, please be advised of your specific policy limitations that may prevent you from establishing a primary care provider out of network or may result in higher out-of-pocket costs.

• Q: What do I do if one of the out of network plans is my only option?

  A: If you are enrolled in a Medicare Advantage plan as part of your retirement benefit through your employer, we encourage patients to bring this concern to your benefits representative to explore specific options available to you. Traditional Medicare is always another option.

• Q: What are the differences in coverage between traditional Medicare and Medicare Advantage plans?

  A: From the hospital perspective, choosing traditional Medicare offers you the most comprehensive coverage available. Medicare.gov has many resources comparing the two types of coverage.

• Q: How do I change my plan?

  A: If you are enrolled in a Medicare Advantage plan, you have the opportunity to explore plans and select one that is right for you during open enrollment. Please contact your benefits representative for details about your open enrollment period and plan offerings. To change back to traditional Medicare from a Medicare Advantage plan, your need to contact your current Medicare Advantage plan provider to cancel your enrollment and then call Medicare helpline at 1-800-MEDICARE (1-800-633-4227) to officially switch back to Original Medicare

  The Medicare open enrollment period is October 15 to December 7. Any change you make during open enrollment will be effective January 2025. There will be another opportunity to make changes to your policy in January of 2025. Between January 1- March 31 you can switch Medicare Advantage plans or to traditional Medicare from a Medicare Advantage Plan.

• Q: Will I be turned away for Emergency Services

  A: Per the EMTALA act, no patients will ever be turned away for emergent/urgent services. In accordance with the federal No Surprises Act, emergency services must be provided as in network for those covered by health insurance through an employer (including a federal employees health benefits plan), the federal health insurance marketplace, a state-based marketplace or other individual market coverage.

UPDATED: November 6, 2024